By,Faiza jawad dawood

H.O.D Dar Ul Sukun

What is ADHD ?

•Attention deficit hyperactive disorder commonly known as ADHD.

•Neurodevelopment disorder. •Most common childhood disorder.•Continue to adolescence to

adulthood.

SYMPTOMS

SUBTYPES• Combined Type

▫ Clinical levels of both inattention and hyperactivity/impulsivity

▫ Most common subtype• Predominantly Inattentive Subtype

▫ Clinical levels of inattention only▫ Often not identified until middle school▫ Sluggish cognitive tempo

• Predominantly Hyperactive/Impulsive Subtype▫ Clinical levels of hyperactivity/impulsivity only▫ More common among very young children prior to school entry

Combined type• Combine symptoms of either two forms of

ADHD.• The most common form.• Diagnosed in boys of elementary-school

age.• Diagnosed when six or more symptoms

associated with each of the two major forms of ADHD are present.

Predominantly inattentive• Difficulty paying attention.• Struggles to concentrate and complete

tasks forget full and easily distracted.• Poor organization skills ,

lethargic ,sluggish ,shy ,anxious or constantly daydreaming.

• Most often diagnosed in adolescent girls, and is diagnosed if six or more symptoms of inattention have persisted for more than six months .

Predominantly hyperactive/impulsive ADHD

• Difficulty controlling behavior ,with an increase risk for serious aggressive or oppositional behavior and anti-social conduct.

• Fidget and excessively restless.• Blurt out comments that are

inappropriate and often do not think before they act.

• Diagnosed if six or more symptoms of hyperactivity persisted for more than six months.

INTERVENTIONSEvidence based treatment include two

categories ;• Pharmacological intervention• Behaviorally based psychosocial

intervention.• Physical exercise

Pharmacological intervention Pharmacological interventions include : Stimulants Non-stimulants• Stimulants are best studied medicine for ADHD.• These medicines improve attention span, self-control, behavior, fine motor control

and social functioning.• Medication is a tool, not a cure. And it is most effective when combined with other

treatments that address emotional and behavioral issues.

Behavioral based psychosocial intervention

• Behavioral therapy, also known as behavior modification.• Behavior therapy involves reinforcing desired behaviors through :

rewards and praise and decreasing problem behaviors by setting limits and consequences.

For example, one intervention might be that a teacher rewards a child who has ADHD for taking small steps toward raising a hand before talking in class, even if the child still blurts out a comment. The theory is that rewarding the struggle toward change encourages the full new behavior

It includes • Parent’s management• School based contingency management.

Parents management

• As parents, you can set up a customized behavioral modification program for your child who has ADD / ADHD with the help of behavioral specialist. such as a cognitive-behavioral therapist

• .This kind of therapist can set up a behavioral modification program of rewards and consequences for your child at home and at school and support you in shaping your child’s behavior.

• Patience is key with behavioral therapy, since people with ADD / ADHD are notoriously variable in their symptoms. One day, your child may behave beautifully, and the next, fall back into old patterns. Sometimes it may seem as if the training is not working. However, over time, behavioral treatment does improve the symptoms of ADHD

ADHD strategies for parents

• Be informed about ADHD and how it affects your child.

• Be upfront about your child's ADHD• Don't overestimate the "power" of medications.•  Learn methods of effective discipline.• Work with your child's teacher(s).• Help provide structure at home for your child.• Create an effective rewards system at home.• Seek out good, professional help.• Do connect with other parents.• Remember to take good care of yourself.

School based contingency

• Many school-based interventions have been developed for students with AD/HD to help them improve their academic and social skills. Among the most researched interventions are:

• Contingency management—This approach combines positive reinforcement for desired behaviors with punishment to reduce unwanted behaviors.

• Cognitive-behavioral—This approach develops student-centered self-control skills and reflective problem-solving strategies that help the student monitor his or her own behavior.

• Academic interventions—This approach focuses on the ways in which subject matter is introduced or taught and on the instructional materials that are used.

According to the American Academy of Pediatrics, there are three basic principles to any behavior therapy approach:

• Set specific goals. Set clear goals for your child such as staying focused on homework for a certain time or sharing toys with friends.Provide rewards and consequences. Give your child a specified reward (positive reinforcement) when he or she shows the desired behavior. Give your child a consequence (unwanted result or punishment) when he or she fails to meet a goal.Keep using the rewards and consequences. Using the rewards and consequences consistently for a long time will shape your child's behavior in a positive way.

Social skills training• Because kids with attention deficit disorder often have difficulty with simple

social interactions and struggle with low self-esteem, another type of treatment that can help is social skills training.

• Normally conducted in a group setting, social skills training is led by a therapist who demonstrates appropriate behaviors and then has the children practice repeating them.

• A social skills group teaches children how to “read” others’ reactions and how to behave more acceptably.

• The social skills group should also work on transferring these new skills to the real world.

ADHD and Exercise

Physical and mental exercise

• Exercising is one of the easiest and most effective ways to reduce the symptoms of

ADD/ADHD. • Physical activity immediately boosts the brain’s dopamine, norepinephrine, and

serotonin levels—all of which affect focus and attention. • Activities that require close attention to body movements, such as dance,

gymnastics, martial arts, and skateboarding, are particularly good for kids with ADD/ADHD. Team sports are also a good choice. The social element keeps them interesting.

Includes :• Simple repetitive motions (running, walking)• Complex physical and mental activities (sport games ,obstacles ,video games)

Simple physical exercises Aerobic exercises help to boost neurotransmitter production, help increase new cell

growth  the brain and can improve executive function. Some examples of aerobic exercises are:

1. Relaxation i.e. positive imagery exercises 2. Running3. Swimming4. Walking5. Rowing6. Jumping Rope7. Dancing

Brain exercises • Mind-body integration• Cross-word puzzles and picture puzzles • Memory and concentration games• Computer games• meditations

Complex physical and mental exercise

Complex exercises that use both physical activity and require a skill help to improve the formation of synaptic networks in the brain. These types of activities include

• Rock climbing• Martial arts

Strategies for exercise Make strategies for exercise ;• Mode • Intensity• Frequency• Duration• Make short term goals• Long term goals (depending upon the severity)• Make your goals measurable and realistic cause every child is

different

Tips for supporting your Childs treatment

• Consistency is key• In order to encourage positive change in all settings, children

with ADD / ADHD need consistency. It is important that parents of children with ADD / ADHD learn how to apply behavioral therapy techniques at home. Children with ADD/ADHD are more likely to succeed in completing tasks when the tasks occur in predictable patterns and in predictable places, so that they know what to expect and what they are supposed to do.

• Follow a routine. It is important to set a time and a place for everything to help a child with ADD/ADHD understand and meet expectations. Establish simple and predictable rituals for meals, homework, play, and bed.

Cont..• Use clocks and timers. Consider placing clocks throughout the house,

with a big one in your child’s bedroom. Allow plenty of time for what your child needs to do, such as homework or getting ready in the morning.

• Simplify your child’s schedule. Avoiding idle time is a good idea, but a child with ADD/ADHD may become even more distracted and “wound up” if there are too many after-school activities.

• Create a quiet place. Make sure your child has a quiet, private space of his or her own. A porch or bedroom can work well too—as long as it’s not the same place as the child goes for a time-out.

• Set an example for good organization. Set up your home in an organized way. Make sure your child knows that everything has its place. Role model neatness and organization as much as possible.

REMEMBER!!!!!

Children with ADHD are often very intelligent it depends how we look at them because..just don’t look at them with your open eyes..but with your open brain…

Thank you